Delirium Flashcards
What is delirium?
an acute transient and reversible state of confusion
What are the two main types, what are their sx?
1. Hyperactive: − Agitation − Delusions − Hallucinations − Wandering − Aggression 2. Hypoactive − Lethargy − Slowness w everyday tasks − XS sleeping − Inattention
Why is one type easily misdiagnosed?
can be confused w depression due to slowness and tiredness
What are the causes of delirium?
Constipation Hypoxia Infection (e.g. UTI) Metabolic disturbance Pain Sleeplessness Prescriptions Hypothermia/pyrexia Organ dysfunction (hepatic/renal) Nutrition Environmental changes Drugs (OTC, illicit, recreational, pets, alcohol and smoking)
What is important to assess in a pt w delirium?
Hx
current diagnoses - consider dementia + depression as standalone causes
meds
vascular problems - strokes, MI, ischaemic limbs increase likelihood of vascular dementia
What is involved in a confusion screen? briefly
- Early warning scores
- CT head
- Lab ix
- CXR
- Blood cultures
- Urine dipstick/culture
Explain the reasons for the ix in a confusion screen
- EWS - vitals indicate signs of sepsis/dehydration
- CT head - rule out ischaemic stroke, intracranial bleeds, space occupying lesions
- FBC - WCC (infection), anaemia, increased MCV (macrocytic anaemia caused by B12/folate deficiency)
U&E - sodium levels
LFTs - liver failure, malnutrition, alcohol abuse
INR - warfarin and intracranial bleeds
TFT - hypothyroid state
Calcium - hypercalcaemia often causes
Glucose - hypoglycaemia can cause - CXR - source of infection
- UTI
What is the management of delirium?
Treat precipitating cause
optimise supportive surroundings and nursing care
avoid sedation
Haloperidol or olanzapine
When is sedation indicated in delirium?
extreme agitation
risk
needed for investigations to take place
Why are benzodiazepines not indicated in delirium?
they worsen delirium (except in alcohol withdrawal)
